Have you had your anterior cruciate ligament (ACL) reconstructed?
It’s a fairly common injury for people who play sports that involve lots of twisting, turning and jumping like footy, rugby, netball and soccer.
The standard procedure for repairing the structure is an operation that replaces your torn ligament with another tendon, normally from your hamstring.
Then the rehabilitation process starts. We need to work on getting you to:
– improve your range of movement
– reduce the swelling
– getting the muscles to activate again
– walk and jog without a limp (If you’ve had this operation, you will know this stage oh so well)
By around 6 months after your operation (maybe a little earlier depending on your progress) you will be running again with more confidence. It is around this time that a lot of the other exercises and strength work often stop. The general assumption is that once you’re back running, the hard work is done.
BUT – THIS IS ONLY THE HALF WAY POINT!!!
Just because you are able to run in a straight line, does not mean your knee is ready to return to sport.
The twisting, turning and jumping that most sports demand may cause too much strain, too early in your recovery.
Before you can go back to play, we work on:
– change of direction drills
– dynamic strength and control
– also sports specific exercises
Without developing these skills, you can increase your risk of further injury!!!!
This is where it’s really important to continue to get check ups and advice from a physiotherapist until you’re back playing sport comfortably without any issues. At myPhysioSA, we regularly assess your strength, movement and control of your knee with a range of tests throughout the course of your ACL rehabilitation that show us, and you, how your knee is improving and identifies what areas you still need to work on.
This is really important, especially from the six month mark on. We need to highlight those areas where your knee is not so good so that we can give you exercises to work on to help you get ready to return to sport.
Sports Specific Examples
What if a netballer has concentrated alot on her running ability after surgery? Let’s say she can run 10km with no real problems.
If I put her through a range of tests designed to mimic the requirements that her knee will demand during a netball game, let’s see what she can do:
– She can’t hop well on her operated side compared to her regular knee
– She can only balance for 10 seconds on one leg on her operated side, compared to 30 seconds
After these tests, it shows that we need to focus on her balance, single squats and hopping to improve these areas.
It’s going to be just as important for her to be able to hop and land well on her operated leg as it is for her to be able run 10 kms.
Another example would be a footballer recovering from and ACL reconstruction who is doing well with his strength and running at 10 months post-op, but when we look closely at his ability to change direction – we can see that his foot positioning is poor and he actually twists through his hip and knee as he goes to push off putting potentially more strain on his knee and ACL.
In this situation we have to work on some cutting drills where he walks through the drill first getting the correct foot placement and body position then adds on speed as long as he can control the hip and knee when he turns. We then make it harder by increasing the sharpness of the turn, and in repetitive turns and then add some random elements to the exercise – meaning he has to respond to an instruction to turn left or right at the last second. In this way we can get his turning ability much better and he is well prepared to head back to playing footy.
No matter what stage of your ACL reconstruction you are at, a physiotherapist can help with your rehab. We are seeing a growing number of people coming in before their surgery so we can develop a plan to prepare them for the procedure and also get a plan for recovery set up. That way, you know exactly what you need to do and will be able to get through your rehab with the support of your physio and surgeon.
Feel free to book an assessment with a physio today to continue your rehab or develop a pre-surgery plan.
Joshua Stewart, myPhysioSA Associate Physiotherapist